Why Do I Need Healthcare?

Health Coverage Helps Pay Costs When You Need Care

No one plans to get sick or hurt, but most people need medical care at some point. Health coverage helps pay for these costs and protects you from very high expenses.

1What is Health Insurance?

Health insurance is a contract between you and your insurance company. You buy a plan, and the company agrees to pay part of your medical costs when you get sick or hurt.
There are other important benefits of health insurance. Plans available in the Marketplace (and most other plans) provide free preventive care, like vaccines and check-ups. They also cover some costs for prescription drugs.
Health insurance helps you pay for care
Did you know the average cost of a 3-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7,500? Having health coverage can help protect you from high, unexpected costs like these.
Your insurance policy or summary of benefits and coverage will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.

2Get Covered to Avoid Penalty

By 2014, everyone in the United States must be covered through the marketplace, their job, public coverage or a qualifying private insurance. Otherwise, they will be subject to a penalty when paying their taxes.

The penalty applies to all individuals that do not qualify for an exemption and will be as follows:

2014: Penalty will be either 1% of family income OR $95 per adult and $47.50 per child (up to $285 per family) – whichever is greater.

2015: Penalty will be either 2% of family income OR $325 per adult and $162.5 per child (up to $975 per family) – whichever is greater.

2016: Penalty will be either 2.5% of family income OR $695 per adult and $347.50 per child (up to $2,085 per family) – whichever is greater.

You’ll usually pay a premium every month for health coverage, and you may also have to meet a deductible once each year before the insurance company starts to pay its share.
How much you pay for your premium and deductible is based on the type of coverage you have.
Just as important as the premium cost is how much you have to pay when you get services.

4Examples Include

How much you pay for care before your insurance company starts to pay its share (a deductible)

What you pay out-of-pocket for services after you pay the deductible (coinsurance or copayments)

How much in total you’ll have to pay if you get sick (the out-of-pocket maximum)

What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover many services and treatments.